| NPI | 1578508552 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: WA PA60105118) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: OR PA00863) |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2010-02-11 |